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Life
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Advanced Strategies in Fracture Treatments
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Advanced Strategies in Fracture Treatments

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: 30 January 2025 | Viewed by 4956

Special Issue Editors

Dr. Kai-Cheng Lin

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan
Interests: pelvic and acetabular trauma; complex lower extremity trauma; periarticular fracture
Dr. Chun-Yu Chen

E-Mail Website
Guest Editor
Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Kaohsiung 813, Taiwan
Interests: hand surgery; microscopic surgery; complex upper extremity trauma

Special Issue Information

Dear Colleagues,

Fracture management is a critical aspect of orthopedic care, and the "Advanced Strategies in Fracture Treatments" Special Issue aims to bring together cutting-edge research and innovative approaches to address contemporary challenges in this field. This Special Issue provides a platform for researchers, clinicians, and experts to share insights into novel treatment modalities, technological advancements, and evidence-based practices that can enhance patient outcomes.

The rationale behind this Special Issue lies in the evolving landscape of fracture treatments, where new strategies are continuously emerging to optimize patient care. We invite contributions that explore a wide range of topics, including biomechanics, surgical techniques, implant developments, and advanced treatment protocols. Authors are encouraged to delve into the complexities of fracture classifications, individualized treatment plans, and the role of emerging technologies in improving diagnostic accuracy and therapeutic interventions.

Our goal is to assemble a collection of articles that not only reflect the current state of the art in fracture treatments but also anticipate future directions in the field. By fostering collaboration and sharing expertise, this Special Issue aims to provide a comprehensive resource for practitioners and researchers seeking to advance the science and practice of fracture management.

Prospective authors are invited to contribute original research articles, reviews, and clinical studies that contribute to the advancement of fracture treatments. We believe that this Special Issue will serve as a valuable reference for professionals seeking to stay at the forefront of innovative approaches to fracture care.

Dr. Kai-Cheng Lin
Dr. Chun-Yu Chen
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • state of the art
  • peri-articular fracture
  • osteoporotic fracture
  • fragility fracture
  • treatment protocols

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Published Papers (6 papers)

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Research

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14 pages, 3414 KiB  
Article
Treatment of the Distal Forearm Fracture by Volar Dual Window Approach
by Wei-Ting Wang and Chiang-Sang Chen
Life 2024, 14(8), 972; https://doi.org/10.3390/life14080972 - 2 Aug 2024
Viewed by 604
Abstract
Background: Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, [...] Read more.
Background: Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, malreduction and instability of the distal radioulnar joint were not uncommon. We introduced a modified volar dual window approach to treat the distal forearm fracture and evaluate the functional outcomes and complications. Methods: From January 2020 to June 2023, 13 patients with distal forearm fractures underwent open reduction by the modified dual window approach with locking plate fixation. After surgery, splints were applied for two weeks, and the patients underwent postoperative hand therapy for three months. The mean Quick Disabilities of the Arm, Shoulder, and Hand scores, range of motions, grip strength, postoperative radiographic parameters, and complications data were collected. Results: The mean follow-up period was 12.1 months, and the mean age was 52.3 years. Average wrist flexion was 67°, extension 69°, pronation 81°, and supination 79°. Grip strength was 28.3 ± 11.5 kg, which was 88% of the uninjured opposite side. The Visual Analog Scale score during activities was recorded as 0.5 ± 0.9. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14 ± 11.5. The postoperative radiographic parameters were as follows: radial height: 10.8 ± 1.7 mm, radial inclination: 22.6 ± 3.7°, volar tilting: 4.0 ± 3.9°, and ulnar variance: −0.4 ± 1.4 mm. All the patients achieved bone union at the final follow-up. Two patients underwent ulnar implant removal due to irritation symptoms. Neither infection, nor neurovascular injury, nor malreduction developed in these patients. Conclusions: The modified volar dual window approach can achieve good wrist function and distal forearm fracture reduction without increasing neurovascular or wound healing complications. This method is an alternative approach for distal forearm fracture, especially in comminuted distal ulna fracture or distal radioulnar joint incongruity. Full article
(This article belongs to the Special Issue Advanced Strategies in Fracture Treatments)
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10 pages, 6192 KiB  
Article
Usability of Minimal Invasive Surgery for Elbow Dislocation with Coronoid Process Fracture: A Protocol Development Study
by Chun-Cheng Lin, Ming-Fai Cheng, Chien-Shun Wang, Chao-Ching Chiang and Yu-Ping Su
Life 2024, 14(8), 954; https://doi.org/10.3390/life14080954 - 29 Jul 2024
Viewed by 562
Abstract
Objective: The study aims to explain whether or not minimal invasive surgery (MIS) would be feasible in elbow fracture–dislocation with coronoid process fracture. Methods: At Taipei Veterans General Hospital, patients who had elbow dislocations with coronoid process fractures underwent a single surgeon’s MIS [...] Read more.
Objective: The study aims to explain whether or not minimal invasive surgery (MIS) would be feasible in elbow fracture–dislocation with coronoid process fracture. Methods: At Taipei Veterans General Hospital, patients who had elbow dislocations with coronoid process fractures underwent a single surgeon’s MIS techniques which included the fluoroscopy-guided ulnar anteromedial (FGUAM) approach in the stage of reducing the coronoid process. When there is a proximal ulnar fracture, the posterior incision should be necessary, followed by the incision over the lateral or medial elbow for treating radial fractures or ligament injuries. Results: The Flow Diagram for approach recommendation was established on the basis of defining MIS as that which does not include cross-plane dissection. The importance of anterior rigid fixation for the coronoid process was also emphasized. Conclusions: MIS can be achieved by multiple limited surgical incisions. Although the posterior extensile approach is necessary in situations of ulnar metaphysis or ligament avulsion fracture, the FGUAM approach decreases the cross-plane dissection. Full article
(This article belongs to the Special Issue Advanced Strategies in Fracture Treatments)
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14 pages, 14897 KiB  
Article
Conformity of Three Pre-Contoured Clavicular Plates Compared Using Personalized 3D-Printed Models of Clavicles from Patients
by Hyun Seok Song, Yongwon Joh and Hyungsuk Kim
Life 2024, 14(7), 888; https://doi.org/10.3390/life14070888 - 18 Jul 2024
Viewed by 607
Abstract
The human clavicle’s unique S-shaped, three-dimensional structure complicates fracture management. This study evaluated the anatomical conformity of pre-contoured anatomical plates using 3D-printed clavicle models. CT scans from 30 patients (15 males and 15 females) were used to create these models. Three brands of [...] Read more.
The human clavicle’s unique S-shaped, three-dimensional structure complicates fracture management. This study evaluated the anatomical conformity of pre-contoured anatomical plates using 3D-printed clavicle models. CT scans from 30 patients (15 males and 15 females) were used to create these models. Three brands of distal clavicle plate systems (Acumed, Synthes, and Arthrex) were tested for fit. Measurements included the distance from the distal end of the clavicle to the plate’s lateral end, the gap between the clavicle and the plate, and the overhang distance. Results showed significant differences in clavicle length between sexes, with men having a mean length of 156.1 ± 7.6 mm and women 138.4 ± 4.3 mm, both with normal distribution (p > 0.05). The mean lateral distance was 7.9 ± 1.7 mm, and the mean medial gap was 3.6 ± 3.0 mm, showing no significant differences between products or sexes. The mean overhang distance was 5.8 ± 4.6 mm, with larger values in women for the Acumed (p = 0.037) and Arthrex (p = 0.000) plates. Overall, pre-contoured plates exhibited notable discrepancies, especially in shorter clavicles. Full article
(This article belongs to the Special Issue Advanced Strategies in Fracture Treatments)
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10 pages, 940 KiB  
Article
A New Postoperative Stability Score to Predict Loss of Reduction in Intertrochanteric Fractures in Elderly Patients
by Shih-Heng Sun, Chun-Yu Chen and Kai-Cheng Lin
Life 2024, 14(7), 858; https://doi.org/10.3390/life14070858 - 9 Jul 2024
Viewed by 807
Abstract
The study aimed to validate a newly developed postoperative stability score for evaluating clinical follow-up in elderly patients with low-energy hip fractures. From 1 January 2020 to 31 December 2021, we enrolled patients aged over 65 who underwent cephalomedullary nail fixation using proximal [...] Read more.
The study aimed to validate a newly developed postoperative stability score for evaluating clinical follow-up in elderly patients with low-energy hip fractures. From 1 January 2020 to 31 December 2021, we enrolled patients aged over 65 who underwent cephalomedullary nail fixation using proximal femoral nail antirotation II (PFNAII) and had at least 6 months of follow-up; excluding multiple fractures, pathological fractures, and periprosthetic fractures. We collected general patient data. Parameters such as TAD, Parker’s ratio (AP and lateral), and the new postoperative stability score were recorded. A loss of reduction was defined using the decline in the Chang reduction quality criteria (CRQC) score within one month. Among the 108 enrolled patients, 23 (21.3%) experienced a loss of reduction, with a mean age of 82.1 years and a mean follow-up time of 7.4 months. Univariate analysis showed no significant association between loss of reduction and general data. However, the new postoperative stability score correlated significantly with loss of reduction (mean scores: 6.68 vs. 4.83, p = 0.045). Multivariate analysis confirmed this association (odds ratio: 0.076, 95% confidence interval: 0.022–0.263, p < 0.05). The newly developed postoperative stability score, incorporating surgical technique assessment, improves prediction accuracy for loss of reduction in elderly intertrochanteric fracture (ITF) patients. Full article
(This article belongs to the Special Issue Advanced Strategies in Fracture Treatments)
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11 pages, 6976 KiB  
Article
Is Staged Surgery Always Necessary for Schatzker Type IV–VI Tibial Plateau Fractures? A Comparison Study
by Kai-Cheng Lin, Fu-Ting Huang, Chun-Yu Chen and Yih-Wen Tarng
Life 2024, 14(6), 753; https://doi.org/10.3390/life14060753 - 13 Jun 2024
Viewed by 946
Abstract
Aims: This study aims to compare the outcomes of immediate (followed by closed-incision negative-pressure therapy use) versus delayed ORIF in patients with Schatzker type IV–VI TPFs. Patients and Methods: A prospective study of patients undergoing ORIF between January 2018 and December 2019 was [...] Read more.
Aims: This study aims to compare the outcomes of immediate (followed by closed-incision negative-pressure therapy use) versus delayed ORIF in patients with Schatzker type IV–VI TPFs. Patients and Methods: A prospective study of patients undergoing ORIF between January 2018 and December 2019 was performed. The inclusion criteria were patients (>18 years) with a closed fracture sent to the emergency room (ER) within 24 h of injury. All the patients underwent preoperative image evaluation. Two senior orthopedic trauma surgeons evaluated the soft tissue condition in the ER by 5P’s of the compartment syndrome, judging the timing of the operation of definitive ORIF. Group 1 (n = 16) received delayed ORIF. Group 2 (n = 16) received immediate ORIF and ciNPT use. Patient follow-up occurred after 2 and 6 weeks and 3, 6, and 12 months after surgery. The assessments included the time to definitive fixation, the length of hospital stay, the time to bone union, surgical site complications, and reoperation within 12 months. A universal goniometer was used to measure the postoperative 3 m, 6 m, and 12 m ROM. Results: The patient demographics were similar between the groups (p > 0.05). Group 2 displayed significantly a shorter time to definitive fixation (5.94 ± 2.02 vs. 0.61 ± 0.28, p < 0.0001) and hospital stay (14.90 ± 8/78 vs. 10.30 ± 6.78, p = 0.0016). No significant difference was observed in the time to bone union, surgical site complication incidence, and reoperation rates (p > 0.05). Flexion and flexion–extension knee ROM were demonstrated to be significantly improved in Group 2, 3, 6, and 12 months postoperatively (p < 0.0001). Conclusions: In this study, early ORIF and ciNPT use resulted in a shorter hospital length of stay, a reduced time to early active motion of the knee, and improved knee ROM. These results suggest that early ORIF with ciNPT for Schatzker type IV–VI TPFs is safe and effective in some patients. However, further research to confirm these findings across larger and more diverse populations is needed. Full article
(This article belongs to the Special Issue Advanced Strategies in Fracture Treatments)
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Review

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12 pages, 1189 KiB  
Review
Management of Extra-Articular and Intra-Articular Distal Radius Malunion
by Ting-Yu Liu and Chen-Yuan Yang
Life 2024, 14(9), 1177; https://doi.org/10.3390/life14091177 - 19 Sep 2024
Viewed by 516
Abstract
This article presents a comprehensive overview of managing extra-articular and intra-articular distal radius malunions (DRM), discussing the pathoanatomy, clinical, and radiologic evaluation, conservative treatment, and surgical strategies. Corrective osteotomy remains the primary surgical intervention for symptomatic DRM. Surgical planning should consider factors such [...] Read more.
This article presents a comprehensive overview of managing extra-articular and intra-articular distal radius malunions (DRM), discussing the pathoanatomy, clinical, and radiologic evaluation, conservative treatment, and surgical strategies. Corrective osteotomy remains the primary surgical intervention for symptomatic DRM. Surgical planning should consider factors such as timing, approach, correction technique, implant, graft, and associated injuries. The correction of extra-articular malunion necessitates brachioradialis tenotomy, circumferential periosteum release, and intrafocal elevation with grafting to facilitate distal radius realignment following osteotomy. Computer-assisted planning with 3D-printed patient-specific instrumentation (PSI) could help execute extra-articular osteotomy with high precision. As for the management of intra-articular malunion, it may require wrist arthrotomy, arthroscopy, or PSI assistance for precise articular osteotomy and reduction of the joint surface. This review highlights the importance of early intervention, thorough preoperative planning, and appropriate surgical techniques to optimize outcomes and minimize complications. Future research should focus on large-scale randomized controlled trials to compare different surgical methods, particularly for intra-articular DRM. Full article
(This article belongs to the Special Issue Advanced Strategies in Fracture Treatments)
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